In the first half of the 20th century, many people were not aware of the hazards of smoking. By 1950, however, there was strong evidence that smoking was a cause of lung cancer. In 1964, the Surgeon General of the United States issued a report about the negative health effects of tobacco use (Table 1). Yet, despite of all the information gathered since then, smoking still remains the leading preventable cause of death in this country. (Obesity is second.)
Between 1995 and 1999, smoking caused approximately 440,000 early deaths each year. More than 12 million early deaths have been blamed on smoking since the first Surgeon General's report. Today, 8.6 million people in the United States have serious smoking-related illnesses. Women are affected by tobacco use more than men, even though fewer women smoke.
The number of diseases caused by smoking has continued to increase. The latest report shows that smoking has an effect on nearly every organ of the body.
The rates of smoking are continuing to decrease, and today most public buildings and workplaces are smoke-free. However, 46 million adults in the United States still smoked cigarettes in 2001. People who smoke may not understand or they may choose to ignore all of the risks listed on the labels of tobacco products.
Smokers who do quit can lower their risks of contracting diseases caused by smoking and can improve their overall health. Unfortunately, for some diseases, such as lung cancer, the risk in former smokers remains higher than in persons who never smoked. This fact makes it even more important for anyone? particularly a teenager?who thinks about smoking to consider all of the possible hazards.
Stop Smoking Completely!
The best choice is to stop smoking completely. Giving up the habit is one of the most important things people can do for their health.
In some cases, people continue to smoke after developing a disease. They assume that the damage has already been done. Studies have shown that nearly 38% of patients with emphysema still smoke, and almost 25% of those with asthma still smoke. Some patients with heart disease, high blood pressure, or diabetes also continue to smoke. It is always beneficial to stop smoking.
Tobacco smoke contains nicotine and more than 60 chemicals that can cause cancer. Nicotine is highly addictive. It has the same effect as amphetamines and cocaine. Thus, many smokers suffer from tobacco dependence. This chronic illness can be treated by gradually reducing the craving for nicotine. A number of nicotine products are available that supply the drug in a lower dose and at a slower rate than cigarettes (Table 2).
Help Is Available!
Most smoking-cessation products are available over the counter. Almost all of the manufacturers have Web sites that will provide support. Doctors and pharmacists can offer advice on selecting the one product, or combination of products, most appropriate. Many pharmacists also offer programs designed to help people quit smoking.
Oral nicotine is sold as gum or lozenges. The gum and lozenges are used for up to 12 weeks. The number used daily slowly decreases over time.
Nicotine patches deliver the drug more slowly than the oral forms. They are available in 3 strengths. Most can be worn for either 16 or 24 hours. They generally are worn for 8 to 10 weeks.
A combination of products can be used by people who do not respond to a single product. If a patient continues to crave a cigarette while wearing a patch, he or she also can use the gum or lozenges to help ease the pangs of withdrawal from nicotine.
Nicotine nasal sprays and inhalers are available by prescription and come with information leaflets.
A number of oral medications or herbals are used as smoking-cessation drugs. One oral medication, Zyban, is available by prescription only.
Much information can be found today about the hazards of smoking. The Surgeon General's report listed more than 1600 articles related to the hazards of tobacco. The Centers for Disease Control and Prevention's Web site (www.cdc.gov) is a good place to start. One can also call 800-CDC-1311 (800-232-1311).
Mr. Sherman is president of Sherman Consulting Services Inc.
The Oncology Care Pharmacist in Health-System Pharmacy
According to the National Cancer Institute, almost 40% of men and women will be given a diagnosis of some form of cancer in their lifetime.
News from the year's biggest meetings
Clinical features with downloadable PDFs